Diurnal blood pressure patterns in normotensive and hypertensive children and adolescents

As abnormalities in diurnal ambulatory blood pressure (BP) have been associated with hypertensive target organ damage in adults, we investigated the diurnal systolic BP (SBP) and diastolic BP (DBP) patterns of 54 normotensive children, age 13.4 +/- 3.0 years, and 45 untreated borderline and mildly hypertensive children, age 14.4 +/- 2.6 years. Subjects wore the SpaceLabs 90207 ambulatory BP monitor for 24 h. BP was measured q 15 min from 08.00-21.00 h then q 30 min from 21.00-08.00 h. Nocturnal BP fall, the night-day ratio and cusum derived measures were calculated from time-weighted daytime and night-time SBP and DBP. The groups were compared using analysis of covariance with adjustment for age, race, gender and body mass index. The influence of age, gender and race on the diurnal BP profile was also examined. Nocturnal SBP fall was greater in hypertensive compared to normotensive subjects (17.1 +/- 6.7 vs 14.6 +/- 7.1 mm Hg; unadjusted mean +/- s.d., P = 0.022). Normotensive and hypertensive groups did not differ in nocturnal DBP fall or SBP or DBP night-day ratio. Race appeared to influence the diurnal BP pattern as black subjects had less nocturnal SBP fall (12.9 +/- 6.9 vs 17.1 +/- 6.5 mm Hg; P < 0.005) and a higher night-day SBP ratio (90.1 +/- 5.3 vs 86.7 +/- 4.6%; P < 0.005) than white subjects. In conclusion, hypertensive children and adolescents have a similar diurnal BP pattern as their normotensive counterparts, except that the entire BP profile is shifted upward with a greater absolute fall in SBP at night. Race also appears to influence the diurnal BP profile of normotensive and hypertensive children and adolescents.     

Distribution and correlates of creatinine clearance in children and adolescents with blood pressure elevation

The kidney has been implicated as both an etiologic factor and as a target organ in patients with essential hypertension. Renal function has not been studied extensively in children and adolescents with essential hypertension. Eighty-eight subjects, aged 6 to 23 years, with blood pressure persistently above the 90th percentile for age were studied. Creatinine clearance was determined from a single 24-hour urine collection. The mean creatinine clearance was 129.3 +/- 55.3 ml/min per 1.73 m2. Multiple regression analysis was used to investigate potential correlates of creatinine clearance. Because creatinine clearance was not normally distributed, the logarithm of creatinine clearance was used as the dependent variable. Body mass index, resting heart rate, and basal supine plasma renin activity were significant direct independent correlates. Peripheral vascular resistance at maximal exercise was an inverse correlate of the logarithm of creatinine clearance. These findings are consistent with previous studies of adults and may provide the basis for strategies to identify young patients with essential hypertension who are at risk for the development of renal dysfunction.     

Exercise tolerance and blood pressure response to exercise testing in children and adolescents after renal transplantation

Intrauterine growth retardation (IUGR), defined as birth weight and/or length less than 3rd percentile (P) or less than-2 standard deviations (SD), concerns about 3% of newborns. About 85% born IUGR show spontaneous postnatal catch-up to a height > P3 or > -2 SD during the first two years of life. After the age of 4 year, the children without catch-up will remain short up to final height. Classical growth hormone (GH) deficiency usually does not seem responsible for the absence of catch-up in those children. A two-year GH therapy at supraphysiological doses increases growth velocity. The effect of this treatment on final height remains to be studied, as well as optimal treatment's modalities. Attention should be paid on the possible side-effects. Finally, the evaluation of the psychological impact of GH treatment will be critical.     

Obsessive-compulsive disorder in children and adolescents. Epidemiological and clinical aspects

Obsessive-compulsive disorder (OCD) in children and adolescents is apparently a much more common disorder than previously believed. The literature on OCD in children and adolescents is reviewed, and OCD is described as a severe disorder with a poor prognosis for about half of the patients. The clinical picture seems to be the same across different cultures. The most common symptoms are obsessions about dirt and contamination and washing rituals.     

Anger and blood pressure readings in children

The number of dual-specificity protein tyrosine phosphatases has grown considerably in the last few years, and thus it would be helpful to organize these novel enzymes. The simple term "VH1-like" or "dual-specificity" phosphatase does not adequately reflect the different subclasses within this new and important phosphatase subfamily. In this article, we review the salient features of dual-specificity phosphatases and propose a novel classification scheme of these enzymes based on their structural motifs. Classification of dual-specificity phosphatases based on their motifs should serve as a useful organizational framework for bringing together this now large subgroup of phosphatases. Moreover, this classification scheme may hold predictive value, since some of these motifs may hold the key to new, undiscovered functional properties.     

Relation between serum uric acid and blood pressure in adolescents

In adults, serum uric acid is positively associated with blood pressure levels. It is also a predictor of the development of hypertension in normotensive adults. The purpose of this study was to examine the relation of serum uric acid to systolic and diastolic blood pressure in adolescents. The data, from Cycle III of the National Health Examination Survey, consisted of a national probability sample of 6768 youths, 12-17 years old, in the United States. With age, height, weight, and sexual maturity controlled, serum uric acid significantly predicted blood pressure in adolescents. This relationship of uric acid and blood pressure was evident in male, but not female, adolescents. In association with findings from adult studies, these results indicate that uric acid levels may be useful indicators of adolescents at risk for hypertension.     

Longitudinal studies of blood pressure in children

A longitudinal study of six years was conducted to find out the pattern of longitudinal changes of blood pressure and to affirm the "tracking phenomenon" of blood pressure in children in China. We initially measured blood pressure and related parameters of 2,946 children (aged 4-14 years) in 1981 at Fanshan county, Beijing, and then two follow-up remeasurements were conducted in 1985 and 1987, respectively. The results indicated that: the average level of blood pressure increases with age even after adjusting for height and weight; tracking coefficients of systolic blood pressure range from weak to moderate levels, increasing with age. Only 30% of the children whose systolic blood pressure was beyond the 90th percentile of the systolic pressure distribution at the first examination remained at the same region after four years. Multiple stepwise regression was used to determine factors correlated with blood pressure. Our results indicate that systolic blood pressure in children is correlated with body weight, pulse rate, serum glucose and HDL-C, while diastolic blood pressure is correlated only with pulse rate and serum glucose.     

Prevalence and clinical aspects of tuberculosis in children and adolescents in the Primorsk Region

The analysis of epidemiological trends in tuberculosis registered for 13 years in children and adolescents living in the Primorsky Region of Russia discovered a trend to an increase of its incidence rate especially in girls and rural population. The morbidity of children aged 4-6, schoolchildren and adolescents aged 17 reached in 1993 137, 22.9 and 62.8 per 100,000 people, respectively. Tuberculosis of the respiratory organs occurred most frequently. In children tuberculosis of intrathoracic lymph nodes was encounted in 88.2% of new cases, in adolescents focal and infiltrative forms were recorded in 27 and 50.8%, respectively. Worsening of ecological and social situation in the region affected negatively immunological indices in the young population. This necessitates urgent measures to control spreading tuberculosis in the Far East of Russia.     

Racial discrimination and blood pressure: the CARDIA Study of young black and white adults

OBJECTIVES: This study examined associations between blood pressure and self reported experiences of racial discrimination and responses to unfair treatment. METHODS: Survey data were collected in year 7 (1992/93) of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a prospective multisite community-based investigation. Participants included 831 Black men, 1143 Black women, 1006 White men, and 1106 White women 25 to 37 years old. RESULTS: Systolic blood pressure among working-class Black adults reporting that they typically accepted unfair treatment and had experienced racial discrimination in none of seven situations was about 7 mm Hg higher than among those reporting that they challenged unfair treatment and experienced racial discrimination in one or two of the situations. Among professional Black adults, systolic blood pressure was 9 to 10 mm Hg lower among those reporting that they typically challenged unfair treatment and had not experienced racial discrimination. Black-White differences in blood pressure were substantially reduced by taking into account reported experiences of racial discrimination and responses to unfair treatment. CONCLUSIONS: Research on racial/ ethnic distributions of blood pressure should take into account how discrimination may harm health.     

Blood pressure normal values in children and adolescents according to age and height

The assessment of blood pressure in children and adolescents is of great importance in order to gain a better understanding of its pattern of evolution. The authors publish the normal values of blood pressure in Portuguese children and adolescents, according to age and sex, as well as the mean values of the 90th percentile, which are very important to separate normal children from those with high blood pressure. In this study the fifth Korotkoof sound is used to define diastolic blood pressure in all ages. New blood pressure tables are also published, for children and adolescents, that now include the height percentile for age and blood pressure. These new charts have been developed to guide practising clinicians in antihypertensive drug therapy, when indicated.     

Familial aggregation of blood pressure in 558 adopted children

Blood pressure was measured in each member of 398 French-Canadian families with at least one adopted child of the same ethnic origin. Measurements were made at home by a nurse, usually with the subject seated. One comparison per family between parents and randomly chosen index children was made, using age- and sex-adjusted scores. The correlation in blood pressure scores between parents and natural children was highly significant (P less than 0.001), at 10.2% for systolic and 13.7% for diastolic in 140 homes with at least one natural child, but the correlation between parents and adopted children was nonsignificant, at 0.81% and 1.0%, in 398 homes with at least one adopted child. The correlation between pairs of natural children was significant (P less than 0.05), at 7.84% for systolic and 8.41% for diastolic, in 80 homes with more than one natural child but nonsignificant, at 0.49% and 1.69%, respectively, for pairs of adopted children in 138 families with more than one adopted child. It is concluded that heredity explains most of the familial resemblance of blood pressure in children.     

Birthweight and blood pressure among children in Harare, Zimbabwe

AIM: To determine whether poor uterine growth may be associated with increased blood pressure and subsequent hypertension in adulthood. METHODS: A retrospective cohort study of 756 schoolchildren (mean age 6.5 years) was carried out in six low income areas in Harare city, Zimbabwe. Indices of intrauterine growth and blood pressure were assessed. RESULTS: Adjusted for current weight, the children's systolic blood pressure was inversely related to their birthweight; for each decreasing kg of birthweight, systolic blood pressure rose by 1.73 mm Hg (95% CI; 0.181 to 3.28). After adjustment for current weight, systolic blood pressure was also inversely associated with occipito-frontal circumference, but not with birth length or gestational age. Diastolic blood pressure was not associated with any of the intrauterine indices. CONCLUSION: Fetal size may be inversely related to systolic blood pressure in childhood in an African population.     

Dietary calcium, calcium supplementation, and blood pressure in African American adolescents

BACKGROUND: Intake of calcium from the diet is inversely associated with blood pressure in observational studies and animal models but randomized trials in humans have found only small effects of calcium supplementation on blood pressure. A blood pressure-lowering effect of calcium supplementation may thus be restricted to persons with a low intake of calcium from the diet and specific genetic or other characteristics. OBJECTIVE: A randomized trial was conducted to assess the effect of calcium supplementation on blood pressure in African American adolescents. Rapid growth during adolescence may increase calcium requirements, and avoidance of milk and milk products by some African Americans can result in low intake of calcium. DESIGN: One hundred sixteen adolescents (65 girls, 51 boys; mean age: 15.8 y) were given calcium (1.5 g/d) or placebo for 8 wk in a randomized, double-blind, crossover design. Blood pressure was measured after 2, 4, and 8 wk. Dietary calcium was determined with a validated food-frequency questionnaire. RESULTS: The net effect (+/-SE) of calcium supplementation on diastolic blood pressure was a reduction of 1.9 +/- 1.1 mm Hg (P = 0.04, one-tailed t test). Blood pressure reduction was greater in adolescents with lower intake of calcium from the diet (P = 0.003, one-tailed t test for interaction): -4.9 +/- 1.6, -2.3 +/- 1.6, and 1.4 +/- 1.8 mm Hg for change in the lower (0.024-0.067 g Ca/MJ), middle (0.069-0.091 g Ca/MJ), and upper (0.093-0.217 g Ca/MJ) tertiles, respectively. No main effect on systolic blood pressure was detected. CONCLUSION: These findings suggest that calcium supplementation may lower diastolic blood pressure in African American adolescents with low dietary intakes of calcium.     

Social and psychological aspects of contraception in adolescents

Reasons for the high adolescent birthrate in the U.S., medical, psychological, and social repercussions of teenage pregnancy, and facts and myths about sex education and contraception for young people are discussed. About 30% of U.S. women under 20 become pregnant outside marriage, and many more are pregnant when they marry. The reasons for the high pregnancy rates in young people include recent early menarch, which accounts for 94% fertility in 17.5-year-olds, better health, and ignorance about contraception and basic facts about reproduction. Pregnant adolescents risk toxemia, anemia, puerperal morbidity, prematurity, neonatal mortality, and congenital defects such as mental retardation in the baby. They face family alienation, loss of educational and employment opportunities, forced marriage, and high suicide rates in addition to the trials of puberty. Many girls believe that their fertile period is during menses, that pills are dangerous, that they are not fertile. Studies have shown that sex education can lower repeat pregnancies 67%. Recent research has negated the belief that many young women desire pregnancy unconsciously. Current information shows that supplying contraception will not encourage young people to begin having intercourse. Most sex education courses in the U.S. are given after the average teenagers become active sexually. It is believed that contraception should be provided universally for young people, and that parental authorization of contraception would probably mend family ties, certainly better than would unwanted pregnancy.     

More recent aspects of treatment for hypothyroidism and goitre in children and adolescents (author's transl)

According to more recent knowledge L-thyroxine alone is recommended for thyroid hormone replacement therapy, no longer the combination of L-thyroxine and triiodothyronin, since L-thyroxine is converted to triiodothyronine in the periphery of the body. Additional application of triiodothyronine causes unphysiological elevations of blood levels of triiodothyronine. When changing from the combined thyroid hormone therapy to treatment with L-thyroxine alone it is enough in most cases to replace the previous amount of L-thyroxine only; previous recommendations for the dosage of thyroid hormone were rather high. Average requirements of adults for L-thyroxine are around 170 mug per day. Children need about 90--100 mug per m2 body surface per day. -- When hypothyroidism is suspected in newborns or infants no protracted diagnostic procedures are justified with respect to brain development and its requirement of thyroid hormone during this period of life. Replacement therapy should be started within 1--2 days. The exact diagnosis can be established later, for instance during the third day of life when a temporary interuption of treatment for diagnostic purposes has no longer such negative effect on normal brain development. As long as physiological doses of L-thyroxine are used no side effects are to be expected for patients who later turn out to be euthyroid. -- Following exclusion of hyperthyroidism goitres in children and adolescents equally need thyroid hormone replacement therapy to reduce the size or prevent further enlargement or even the development of nodules within the gland. The dosage for this is about half to three quarters of the full replacement dose. The nature of thyroid nodules should be investigated, even surgically, since malignancies can develop in children and juveniles as well as in adults.     

Clinical aspects, therapy and prevention of psychotic disorders in children and adolescents with cerebral residual-organic insufficiency

By means of a follow-up study the author examined 36 patients with cerebral residual insufficiency in the age group from 10-16 years. A psychotic and nonpsychotic variants of this form of pathology was detected. A psychotic decompensation may be evoked by a nonspecific exogenous factor. The clinical picture of a decompensation is characterized by affective disturbances and symptoms of changes consciousness. The treatment programme of the acute period of an exogenous-organic psychosis should include analgetics, desensitation, neuroleptical drugs, lithium carbonate, dehydration and cardio-vascular preparations.     

Trichobezoars in children and adolescents

BACKGROUND: Trichobezoars are composed of hair or fibres. The typical patient presenting with a trichobezoar is an adolescent girl experiencing mental disturbance or retardation. CASE REPORT: Three girls with trichobezoars were seen. Two of them, 4 and 15 years old, had serious digestive antecedents (corrosive oesophagogastritis and oesophageal atresia, respectively) and had undergone previous surgery. The third was a 13-year-old mentally retarded girl. In two cases, an enzymatic dissolution trial was unsuccessful, requiring secondary surgical removal after, in one case, ineffective gastroscopic removal complicated by an oesophageal perforation. The third child had an initial operative removal. DISCUSSION: Serious digestive antecedents may favour bezoars, a diagnosis that must be evoked in such patients presenting with chronic digestive symptoms. Enzymatic dissolution is ineffective for large bezoars, and gastroscopic removal carries some risks such as perforation or intestinal obstruction. Operative removal is usually indicated. Psychiatric follow-up is needed to prevent this complication in children with serious digestive antecedents and to reduce the risk of recurrences.     

Syncope in children and adolescents

OBJECTIVES: The objectives of this study were to 1) define the incidence of syncope coming to medical attention among children and adolescents, 2) determine the outcome of syncope in these patients, and 3) determine changes over time in the evaluation and charges for evaluating this problem. BACKGROUND: Syncope occurs commonly in children and adolescents. However, the mid- and long-term outcome of children and adolescents who experience syncope is unknown. METHODS: Utilizing the Rochester Epidemiology Project, we determined the incidence, outcome and charges for medical evaluation for patients seeking medical attention for syncope during an early 5-year period (1950 to 1954) and a more recent 5-year period (1987 to 1991). RESULTS: The incidence of syncope coming to medical attention was 71.9 and 125.8/100,000 population for the early and more recent cohort, respectively. The incidence was higher for female than for male patients. The incidence peaked in 15- to 19-year old patients. Acute illness and noxious stimuli were associated with 24% and 23% of the episodes, respectively. Although long-term survival was not different from that of the general population, one child died suddenly, and another had hereditary prolonged QT interval syndrome. These were two of only six patients who had exertional syncope. Total charges for evaluation of syncope were similar in the two time periods. However, charges for testing procedures were greater for the more recent cohort. CONCLUSIONS: In general, syncope in children and adolescents is a benign event. Syncope occurring during exercise may identify patients with a potentially fatal condition. Detailed evaluation should be considered for patients who have syncope during exercise or who have a family history of syncope, sudden death, myocardial disease or arrhythmias. It may be prudent to obtain an electrocardiogram for all patients who seek medical attention for syncope.